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Inferior Turbinate classification system, grades 1 to 4: Development and validation study
Author(s) -
Camacho Macario,
Zaghi Soroush,
Certal Victor,
Abdullatif Jose,
Means Casey,
Acevedo Jason,
Liu Stanley,
Brietzke Scott E.,
Kushida Clete A.,
Capasso Robson
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24923
Subject(s) - quartile , medicine , grading (engineering) , kappa , confidence interval , intra rater reliability , grading scale , intraclass correlation , cohen's kappa , nuclear medicine , surgery , mathematics , statistics , psychometrics , clinical psychology , civil engineering , geometry , engineering
Objectives/Hypothesis To develop a validated inferior turbinate grading scale. Study Design Development and validation study. Methods Phase 1 development (alpha test) consisted of a proposal of 10 different inferior turbinate grading scales (>1,000 clinic patients). Phase 2 validation (beta test) utilized 10 providers grading 27 standardized endoscopic photos of inferior turbinates using two different classification systems. Phase 3 validation (pilot study) consisted of 100 live consecutive clinic patients (n = 200 inferior turbinates) who were each prospectively graded by 18 different combinations of two independent raters, and grading was repeated by each of the same two raters, two separate times for each patient. Results In the development phase, 25% (grades 1–4) and 33% (grades 1–4) were the most useful systems. In the validation phase, the 25% classification system was found to be the best balance between potential clinical utility and ability to grade; the photo grading demonstrated a Cohen's kappa (κ) = 0.4671 ± 0.0082 (moderate inter‐rater agreement). Live‐patient grading with the 25% classification system demonstrated an overall inter‐rater reliability of 71.5% (95% confidence interval [CI]: 64.8–77.3), with overall substantial agreement (κ = 0.704 ± 0.028). Intrarater reliability was 91.5% (95% CI: 88.7–94.3). Distribution for the 200 inferior turbinates was as follows: 25% quartile = grade 1, 50% quartile (median) = grade 2, 75% quartile = grade 3, and 90% quartile = grade 4. Mean turbinate size was 2.22 (95% CI: 2.07‐2.34; standard deviation 1.02). Categorical κ was as follows: grade 1, 0.8541 ± 0.0289; grade 2, 0.7310 ± 0.0289; grade 3, 0.6997 ± 0.0289, and grade 4, 0.7760 ± 0.0289. Conclusions The 25% (grades 1–4) inferior turbinate classification system is a validated grading scale with high intrarater and inter‐rater reliability. This system can facilitate future research by tracking the effect of interventions on inferior turbinates. Level of Evidence 2c Laryngoscope , 125:296–302, 2015